Benign positional vertigo (BPV) is the most common cause of pathological vertigo. The cause of about half of the cases of BPV is unknown, particularly in the elderly, while the remaining cases are linked to causes such as head injury, vascular occlusion and viral labyrinthitis. Patients suffering from BPV develop brief episodes of vertigo. This particularly occurs while the patient is changing position in such tasks as bending over and standing up, extending the neck to acquire a more elevated view, getting in and out of bed, and turning over in bed. In most patients the symptoms spontaneously remit, but recurrence is frequent.
A possible cause of BPV is thought to be free-floating calcium carbonate crystals, normally attached to the utricular macule, which accidently enter the long arm of the posterior semicircular canal. One therapy for alleviating the symptoms of BPV has been a bedside positioning maneuver used to remove the debris from the posterior canal on the affected side. This manipulation of the head; however, does not cure all symptoms and requires the patient to visit the office of a medical practitioner capable of performing such a manipulation. BPV has also be treated with the administration of meclazine; however, few patients respond to meclazine.